HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � Permit Number:
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RECEIVED
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Building Permit Application
Planning and Development Services ? ;�
Building and Code Regulation Division G `�
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential MOO 8 2017
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of R eLucie County, FL
Address: 5111 BIRCH DR, FORT PIERCE FL 34982
Legal Description: INDIAN RIVER ESTATES UNIT 07 BLK 50 LOT 29
Property Tax ID#: 3402-608-0377-000-2 Lot No.29
Site Plan Name: Block No. 50
Project Name: BAILEY
Setbacks Front Back: Right Side: Left Side:
fir ,' .✓ rs� e tis^ �� s ,. -rotz'.w °
DETAILE[7 I RIPTDN'K, �sWORK; ;
CHANGE OUT DOOR(S), NO SIZE CHANGE
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Addition"a wor tobenerformed under this permit—check all apply:
❑'HVAC Gas Tank Gas Piping _Shutters a Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ 2032 Utilities:1n Sewer 0 Septic Building Height:
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Name WILLIAM BAILEY/LOIS DEERY Name: JAMES D. DAVIS
Address:5111 BIRCH DR Company: J&G CARPENTRY INC.
City: FORT PIERCE State:FL Address: 13461 79TH CT N
Zip Code: 34982 Fax: City: WEST PALM BEACH State:FL
Phone No.772-408-6134 Zip Code: 33412 Fax: 5617855-4054
E-Mail: Phone No. 561-855-4052
Fill in fee simple Title Holder on next page(if different E-Mail- JGPERMITS@GMAIL.COM
from the Owner listed above) State or County License: CGCO22831
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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ALLAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _ Permit-Number:, .. _
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 -
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: To Select from dropbox,click arrow at the end of line
. =PRQRQSED IIVIPR011EMENT'LOCAION
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Address: 5111 BIRCH DR,FORT PIERCE FL 34982
Legal Description: INDIAN RIVER ESTATES UNIT 07 BLK 50 LOT 29
Property Tax ID#: 3402-608-0377-000-2 Lot No.29
Site Plan Name: Block No. 50
Project Name: BAILEY
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTI;OIV OF'WORIC
CHANGE OUT DOOR(S), NO SIZE CHANGE`
CONS;fRUCTI01"um RMATION _
Additional work to a er orme under t ispermit—c ec�a sappy:
�HVAC ff Gas Tank ❑Gas Piping _Shutters a Windows/Doors i k u 4 .
Electric EJ Plumbing OSprinklers 1:1Generator Roof
Total Sq.Ft of Construction: S Ft,of First Floor:
Cost of Construction:$ 2032 Utilities:Sewer E]Septic Building Height:
OWNEf�/LESSEE , h ;CONTRACTOR, w
._
Name WILLIAM BAILEY/LOIS DEERY Name: JAMES D.DAVIS'
Address-511 i BIRCH DR Company:J&G'CARPENTRY INC. :,'..=•
City: FORT PIERCE State:FL -Address: 13461 79TH CT N
Zip Code: 34982 Fax: City: WEST PALM BEACH State:FL
Phone No.772-408-6134 Zip Code: 33412 Fax
561-855-4054
E-Mail: Phone No. 561-855-4052
Fill in fee simple Title Holder on next page(if different E-Mail: JGPERMITS@GMAIL.COM
from the Owner listed above) State or County License: CGCO2283i
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
-SUPPLEMENTALCONSTRUCTIONCI TN'LAW INFORMATION 4
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
—rce-rtify ffia no wor or rnsta ation as commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply;
Inconsideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection.If you intend to obtain financing,consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
4rtow w�-- S..
_Signature of Owner/Lessee/Agent Si ature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLOR F� �1
COUNTY OF 11!(.•V,% COUNTY OF—Chn Bear
The fo Ding instru nt was acknowledged before me The forgoing instrument was acknowledged before me'
this day of G. 201'7 by this dday of "air- 20 a by
(Name of person acknowledging) (Name of person acknowledging
(Signat of Notary Public-State of Florida) (Signatur f Notary ublic/ to of Florida)
Personally Known OR Produced Identification Personally Known t/OR Produced Identification
Type of Identification Produced L,+t g' Type of Identification Produced
Commission No.fF (SE a
(AvAY0UNGy A1Y COMMISSION#FF 951069
r EXPIRES:April ._
Revised 07/15/2014 EXPIRES June 27,21 FOF F`-e Bonded hru Budget Notary Serrices
r4Q7)39"153 ,FbWdallotaryService.com
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
-COMPLETE _ ---
INITIALS
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